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June 07, 2010

AMA CEJA 2010: ACRE Recommends Rejecting CEJA Report Financial Relationships with Industry in Continuing Medical Education

In response to the American Medical Association Council on Judicial and Ethical Affairs (CEJA) fourth attempt to hinder physician and institution relationships with industry, the Association of Clinical Researchers and Educators (ACRE) recommended that CEJA Report 1-A-10 and its recommendations be rejected by the AMA House of Delegates.

CEJA’s report, entitled “Financial Relationships with Industry in Continuing Medical Education,” without any significant evidence to support their proposal, improperly asks individual physicians and institutions of medicine to not accept industry funding to support professional educational activities.  As a result, ACRE called for the rejection of 1-A-10 for many reasons including:

· CME is already highly regulated to prevent undue influence from industry

· Reducing resources in CME will result in less education of physicians

· With the adoption of Health Care Reform and the subsequent addition of 30 million new patients to the healthcare system, additional financial resources will be needed to educate a greater number of physicians and other healthcare providers not less

· The CEJA report ignores 3 recently published studies, involving very large study populations, which are directly relevant to the Report's subject matter but "contra" to the report's recommendations. By an overwhelming margin, doctors who actually attend commercially sponsored CME do not perceive bias.

· Passage of the Physician Payment Sunshine Provisions in Health Care Reform eliminates the need for more detailed disclosure as recommended in the CEJA report

In ignoring ACRE’s previous response to their third report and ignoring recent evidence that industry support does not produce bias in CME, CEJA’s report is tendentious and contrary to "evidence-based professional ethics because 1-A-10 is virtually the exact same report that has been rejected three times previously by the House of Delegates.

Accordingly, CEJA must realize that CME is already highly regulated by ACCME Standards for Commercial Support and the FDA Guidance already enforce much of what CEJA considers changes and need for a code of conduct. Clearly then, there is no compelling reason or evidence to support their proposed changes.

By neglecting to use any real evidence to support their claims or underscoring health care reform legislation, CEJA’s Report 1-A-10 will only create auditing programs and ask for a magnitude of disclosure that would result in enormous undue administrative burdens on specialty societies and state accredited organizations running thousands of CME programs each year.  This ignorance is particularly problematic because their reliance on the same fifty seven (57) references that were previously rejected still leads them to admit that “to date, there is no empirical evidence to support or refute the hypothesis that CME activities are biased.”

CEJA acknowledges that presently, it “has not been clearly demonstrated to what extent the amount of a financial interest may influence perception and judgment” Instead, CEJA declares that “clear evidence is lacking” and acknowledges that most policies on “conflict of interest” at least tacitly assume that the greater the financial interest, the more problematic that interest is, but without any evidence. What evidence does exist about commercial support of CME?

This past year, three studies produced substantial data that demonstrate a lack of commercial bias in industry-sponsored CME (Cleveland Clinic; Medscape, and UCSF). So what did CEJA do with this data?  Nothing.

In choosing to pick which data CEJA wants to use to support their position and in disregarding this evidence, 1-A-10 is a complete contradiction.  Specifically, while recommending that physicians avoid industry funded CME, CEJA also recognizes that industry support is “vital to the professional community,” a clear example of how 1-A-10 uses faulty reasoning and contradictions. 

CEJA’s mistake is clear by a simple fact that they admit themselves: “in many situations, the only individuals truly qualified to train physicians in the earliest stage of adoption of a new medical device, technique, or technology, are often those who developed the innovation.” If industry support of CME should be avoided, who can teach doctors about new stents or pacemakers, when the person qualified created them?

Their ignorance is even more evident by CEJA’s recognition that there are also numerous circumstances when “access to appropriate, high-quality, independent CME may be seriously impaired if support from industry is refused,” such as when expensive equipment is needed, and accepting funds or in-kind support from multiple, competing firms might result in more independence than refusing such support.

These contradictions clearly confuse and ignore the proposal’s own acknowledgement that “industry support for CME helps to meet the costs of programs and activities in the face of uncertain funding from other sources.” It also reduces “costs to individual attendees and makes CME more accessible, especially for physicians in resource poor communities.” Consequently, since CEJA did not address these clearly conflicting statements, the least they could do is explain how physicians can get CME credits, education and training if in some cases, as CEJA also acknowledges, “CME may not be feasible without industry support.”  They do not however, explain where 50% of the funding for CME will come from and where doctors will get their education if industry funded CME is phased out.

Ultimately, ACRE’s response reflected the organizations belief that there is value to physicians, medicine, medical education, and patients from the working relationship between physicians and industry. There is no conflict in advancing science, and there is no conflict in providing the education that is required to do so.

By working together with industry colleagues, physicians can explain to the public that the contributions of corporations to medicine are, on balance, more beneficial than harmful and that both medicine and the industries that provide it with its technologies are worthy of public support. Cooperation, instead of antagonism, can help industry develop and market therapies with the highest integrity, by keeping physicians current on the best available evidence and by providing excellent patient care.

ACRE’s Response to CEJA 1-A-10

Other articles on CEJA 1-A-10

AMA CEJA 2010: Financial Relationships with Industry in Continuing Medical Education Version 4.0 – Same Report - Same References

AMA CEJA: Strike 4 - Report Perhaps Ushered from the CME Ballpark

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